Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial

Barry Krakow, Michael Hollifield, Lisa Johnston, Mary P Koss, Ron Schrader, Teddy D. Warner, Dan Tandberg, John Lauriello, Leslie McBride, Lisa Cutchen, Diana Cheng, Shawn Emmons, Anne Germain, Dominic Melendrez, Diane Sandoval, Holly Prince

Research output: Contribution to journalArticle

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Abstract

Context: Chronic nightmares occur frequently in patients with posttraumatic stress disorder (PTSD) but are not usually a primary target of treatment. Objective: To determine if treating chronic nightmares with imagery rehearsal therapy (IRT) reduces the frequency of disturbing dreams, improves sleep quality, and decreases PTSD symptom severity. Design, Setting, and Participants: Randomized controlled trial conducted from 1995 to 1999 among 168 women in New Mexico; 95% had moderate-to-severe PTSD, 97% had experienced rape or other sexual assault, 77% reported life-threatening sexual assault, and 58% reported repeated exposure to sexual abuse in childhood or adolescence. Intervention: Participants were randomized to receive treatment (n = 88) or to the wait-list control group (n = 80). The treatment group received IRT in 3 sessions; controls received no additional intervention, but continued any ongoing treatment. Main Outcome Measures: Scores on the Nightmare Frequency Questionnaire (NFQ), Pittsburgh Sleep Quality Index (PSQI), PTSD Symptom Scale (PSS), and Clinician-Administered PTSD Scale (CAPS) at 3- and 6-month follow-up. Results: A total of 114 participants completed follow-up at 3 and/or 6 months. Comparing baseline to follow-up (n = 97-114), treatment significantly reduced nights per week with nightmares (Cohen d = 1.24; P<.001) and number of nightmares per week (Cohen d = 0.85; P<.001) on the NFQ and improved sleep (on the PSQI, Cohen d = 0.67; P<.001) and PTSD symptoms (on the PSS, Cohen d = 1.00; P<.001 and on the CAPS, Cohen d = 1.53; P<.001). Control participants showed small, nonsignificant improvements for the same measures (mean Cohen d = 0.21). In a 3-point analysis (n = 66-77), improvements occurred in the treatment group at 3-month follow-up (treatment vs control group, Cohen d = 1.15 vs 0.07 for nights per week with nightmares; 0.95 vs -0.06 for nightmares per week; 0.77 vs 0.31 on the PSQI, and 1.06 vs 0.31 on the PSS) and were sustained without further intervention or contact between 3 and 6 months. An intent-to-treat analysis (n = 168) confirmed significant differences between treatment and control groups for nightmares, sleep, and PTSD (all P<.02) with moderate effect sizes for treatment (mean Cohen d = 0.60) and small effect sizes for controls (mean Cohen d = 0.14). Posttraumatic stress symptoms decreased by at least 1 level of clinical severity in 65% of the treatment group compared with symptoms worsening or not changing in 69% of controls (χ12 = 12.80; P<.001). Conclusions: Imagery rehearsal therapy is a brief, well-tolerated treatment that appears to decrease chronic nightmares, improve sleep quality, and decrease PTSD symptom severity.

Original languageEnglish (US)
Pages (from-to)537-545
Number of pages9
JournalJournal of the American Medical Association
Volume286
Issue number5
StatePublished - Aug 1 2001

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Imagery (Psychotherapy)
Post-Traumatic Stress Disorders
Survivors
Randomized Controlled Trials
Sleep
Therapeutics
Control Groups
Rape
Sex Offenses

ASJC Scopus subject areas

  • Medicine(all)

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Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder : A randomized controlled trial. / Krakow, Barry; Hollifield, Michael; Johnston, Lisa; Koss, Mary P; Schrader, Ron; Warner, Teddy D.; Tandberg, Dan; Lauriello, John; McBride, Leslie; Cutchen, Lisa; Cheng, Diana; Emmons, Shawn; Germain, Anne; Melendrez, Dominic; Sandoval, Diane; Prince, Holly.

In: Journal of the American Medical Association, Vol. 286, No. 5, 01.08.2001, p. 537-545.

Research output: Contribution to journalArticle

Krakow, B, Hollifield, M, Johnston, L, Koss, MP, Schrader, R, Warner, TD, Tandberg, D, Lauriello, J, McBride, L, Cutchen, L, Cheng, D, Emmons, S, Germain, A, Melendrez, D, Sandoval, D & Prince, H 2001, 'Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial' Journal of the American Medical Association, vol. 286, no. 5, pp. 537-545.
Krakow, Barry ; Hollifield, Michael ; Johnston, Lisa ; Koss, Mary P ; Schrader, Ron ; Warner, Teddy D. ; Tandberg, Dan ; Lauriello, John ; McBride, Leslie ; Cutchen, Lisa ; Cheng, Diana ; Emmons, Shawn ; Germain, Anne ; Melendrez, Dominic ; Sandoval, Diane ; Prince, Holly. / Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder : A randomized controlled trial. In: Journal of the American Medical Association. 2001 ; Vol. 286, No. 5. pp. 537-545.
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abstract = "Context: Chronic nightmares occur frequently in patients with posttraumatic stress disorder (PTSD) but are not usually a primary target of treatment. Objective: To determine if treating chronic nightmares with imagery rehearsal therapy (IRT) reduces the frequency of disturbing dreams, improves sleep quality, and decreases PTSD symptom severity. Design, Setting, and Participants: Randomized controlled trial conducted from 1995 to 1999 among 168 women in New Mexico; 95{\%} had moderate-to-severe PTSD, 97{\%} had experienced rape or other sexual assault, 77{\%} reported life-threatening sexual assault, and 58{\%} reported repeated exposure to sexual abuse in childhood or adolescence. Intervention: Participants were randomized to receive treatment (n = 88) or to the wait-list control group (n = 80). The treatment group received IRT in 3 sessions; controls received no additional intervention, but continued any ongoing treatment. Main Outcome Measures: Scores on the Nightmare Frequency Questionnaire (NFQ), Pittsburgh Sleep Quality Index (PSQI), PTSD Symptom Scale (PSS), and Clinician-Administered PTSD Scale (CAPS) at 3- and 6-month follow-up. Results: A total of 114 participants completed follow-up at 3 and/or 6 months. Comparing baseline to follow-up (n = 97-114), treatment significantly reduced nights per week with nightmares (Cohen d = 1.24; P<.001) and number of nightmares per week (Cohen d = 0.85; P<.001) on the NFQ and improved sleep (on the PSQI, Cohen d = 0.67; P<.001) and PTSD symptoms (on the PSS, Cohen d = 1.00; P<.001 and on the CAPS, Cohen d = 1.53; P<.001). Control participants showed small, nonsignificant improvements for the same measures (mean Cohen d = 0.21). In a 3-point analysis (n = 66-77), improvements occurred in the treatment group at 3-month follow-up (treatment vs control group, Cohen d = 1.15 vs 0.07 for nights per week with nightmares; 0.95 vs -0.06 for nightmares per week; 0.77 vs 0.31 on the PSQI, and 1.06 vs 0.31 on the PSS) and were sustained without further intervention or contact between 3 and 6 months. An intent-to-treat analysis (n = 168) confirmed significant differences between treatment and control groups for nightmares, sleep, and PTSD (all P<.02) with moderate effect sizes for treatment (mean Cohen d = 0.60) and small effect sizes for controls (mean Cohen d = 0.14). Posttraumatic stress symptoms decreased by at least 1 level of clinical severity in 65{\%} of the treatment group compared with symptoms worsening or not changing in 69{\%} of controls (χ12 = 12.80; P<.001). Conclusions: Imagery rehearsal therapy is a brief, well-tolerated treatment that appears to decrease chronic nightmares, improve sleep quality, and decrease PTSD symptom severity.",
author = "Barry Krakow and Michael Hollifield and Lisa Johnston and Koss, {Mary P} and Ron Schrader and Warner, {Teddy D.} and Dan Tandberg and John Lauriello and Leslie McBride and Lisa Cutchen and Diana Cheng and Shawn Emmons and Anne Germain and Dominic Melendrez and Diane Sandoval and Holly Prince",
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TY - JOUR

T1 - Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder

T2 - A randomized controlled trial

AU - Krakow, Barry

AU - Hollifield, Michael

AU - Johnston, Lisa

AU - Koss, Mary P

AU - Schrader, Ron

AU - Warner, Teddy D.

AU - Tandberg, Dan

AU - Lauriello, John

AU - McBride, Leslie

AU - Cutchen, Lisa

AU - Cheng, Diana

AU - Emmons, Shawn

AU - Germain, Anne

AU - Melendrez, Dominic

AU - Sandoval, Diane

AU - Prince, Holly

PY - 2001/8/1

Y1 - 2001/8/1

N2 - Context: Chronic nightmares occur frequently in patients with posttraumatic stress disorder (PTSD) but are not usually a primary target of treatment. Objective: To determine if treating chronic nightmares with imagery rehearsal therapy (IRT) reduces the frequency of disturbing dreams, improves sleep quality, and decreases PTSD symptom severity. Design, Setting, and Participants: Randomized controlled trial conducted from 1995 to 1999 among 168 women in New Mexico; 95% had moderate-to-severe PTSD, 97% had experienced rape or other sexual assault, 77% reported life-threatening sexual assault, and 58% reported repeated exposure to sexual abuse in childhood or adolescence. Intervention: Participants were randomized to receive treatment (n = 88) or to the wait-list control group (n = 80). The treatment group received IRT in 3 sessions; controls received no additional intervention, but continued any ongoing treatment. Main Outcome Measures: Scores on the Nightmare Frequency Questionnaire (NFQ), Pittsburgh Sleep Quality Index (PSQI), PTSD Symptom Scale (PSS), and Clinician-Administered PTSD Scale (CAPS) at 3- and 6-month follow-up. Results: A total of 114 participants completed follow-up at 3 and/or 6 months. Comparing baseline to follow-up (n = 97-114), treatment significantly reduced nights per week with nightmares (Cohen d = 1.24; P<.001) and number of nightmares per week (Cohen d = 0.85; P<.001) on the NFQ and improved sleep (on the PSQI, Cohen d = 0.67; P<.001) and PTSD symptoms (on the PSS, Cohen d = 1.00; P<.001 and on the CAPS, Cohen d = 1.53; P<.001). Control participants showed small, nonsignificant improvements for the same measures (mean Cohen d = 0.21). In a 3-point analysis (n = 66-77), improvements occurred in the treatment group at 3-month follow-up (treatment vs control group, Cohen d = 1.15 vs 0.07 for nights per week with nightmares; 0.95 vs -0.06 for nightmares per week; 0.77 vs 0.31 on the PSQI, and 1.06 vs 0.31 on the PSS) and were sustained without further intervention or contact between 3 and 6 months. An intent-to-treat analysis (n = 168) confirmed significant differences between treatment and control groups for nightmares, sleep, and PTSD (all P<.02) with moderate effect sizes for treatment (mean Cohen d = 0.60) and small effect sizes for controls (mean Cohen d = 0.14). Posttraumatic stress symptoms decreased by at least 1 level of clinical severity in 65% of the treatment group compared with symptoms worsening or not changing in 69% of controls (χ12 = 12.80; P<.001). Conclusions: Imagery rehearsal therapy is a brief, well-tolerated treatment that appears to decrease chronic nightmares, improve sleep quality, and decrease PTSD symptom severity.

AB - Context: Chronic nightmares occur frequently in patients with posttraumatic stress disorder (PTSD) but are not usually a primary target of treatment. Objective: To determine if treating chronic nightmares with imagery rehearsal therapy (IRT) reduces the frequency of disturbing dreams, improves sleep quality, and decreases PTSD symptom severity. Design, Setting, and Participants: Randomized controlled trial conducted from 1995 to 1999 among 168 women in New Mexico; 95% had moderate-to-severe PTSD, 97% had experienced rape or other sexual assault, 77% reported life-threatening sexual assault, and 58% reported repeated exposure to sexual abuse in childhood or adolescence. Intervention: Participants were randomized to receive treatment (n = 88) or to the wait-list control group (n = 80). The treatment group received IRT in 3 sessions; controls received no additional intervention, but continued any ongoing treatment. Main Outcome Measures: Scores on the Nightmare Frequency Questionnaire (NFQ), Pittsburgh Sleep Quality Index (PSQI), PTSD Symptom Scale (PSS), and Clinician-Administered PTSD Scale (CAPS) at 3- and 6-month follow-up. Results: A total of 114 participants completed follow-up at 3 and/or 6 months. Comparing baseline to follow-up (n = 97-114), treatment significantly reduced nights per week with nightmares (Cohen d = 1.24; P<.001) and number of nightmares per week (Cohen d = 0.85; P<.001) on the NFQ and improved sleep (on the PSQI, Cohen d = 0.67; P<.001) and PTSD symptoms (on the PSS, Cohen d = 1.00; P<.001 and on the CAPS, Cohen d = 1.53; P<.001). Control participants showed small, nonsignificant improvements for the same measures (mean Cohen d = 0.21). In a 3-point analysis (n = 66-77), improvements occurred in the treatment group at 3-month follow-up (treatment vs control group, Cohen d = 1.15 vs 0.07 for nights per week with nightmares; 0.95 vs -0.06 for nightmares per week; 0.77 vs 0.31 on the PSQI, and 1.06 vs 0.31 on the PSS) and were sustained without further intervention or contact between 3 and 6 months. An intent-to-treat analysis (n = 168) confirmed significant differences between treatment and control groups for nightmares, sleep, and PTSD (all P<.02) with moderate effect sizes for treatment (mean Cohen d = 0.60) and small effect sizes for controls (mean Cohen d = 0.14). Posttraumatic stress symptoms decreased by at least 1 level of clinical severity in 65% of the treatment group compared with symptoms worsening or not changing in 69% of controls (χ12 = 12.80; P<.001). Conclusions: Imagery rehearsal therapy is a brief, well-tolerated treatment that appears to decrease chronic nightmares, improve sleep quality, and decrease PTSD symptom severity.

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